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Published in: BMC Neurology 1/2015

Open Access 01-12-2015 | Study protocol

Serum biomarkers for the early diagnosis of TIA: The MIND-TIA study protocol

Authors: L. Servaas Dolmans, Frans H. Rutten, Marie-Louise EL Bartelink, Gerdien Seppenwoolde, Sanne van Delft, L. Jaap Kappelle, Arno W. Hoes

Published in: BMC Neurology | Issue 1/2015

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Abstract

Background

A Transient Ischaemic Attack (TIA) bears a high risk of a subsequent ischaemic stroke. Adequate diagnosis of a TIA should be followed immediately by the start of appropriate preventive therapy, including antiplatelets. The diagnosis of a TIA based on symptoms and signs only is notoriously difficult and biomarkers of brain ischaemia might improve the recognition, and target management and prognosis of TIA patients. Our aim is to quantify the added diagnostic value of serum biomarkers of brain ischaemia in patients suspected of TIA.

Methods/design

Study design: a cross-sectional diagnostic accuracy study with an additional six month follow-up period.
Study population: 350 patients suspected of TIA in the primary care setting.
Patients suspected of a TIA will be recruited by at least 200 general practitioners (GPs) in the catchment area of seven TIA outpatient clinics willing to participate in the study. In all patients a blood sample will be drawn as soon as possible after the patient has contacted the GP, but at least within 72 h after onset of symptoms. Participants will be referred by the GP to the regional TIA outpatient clinic for additional investigations, including brain imaging. The ‘definite’ diagnosis (reference standard) will be made by a panel consisting of three experienced neurologists who will use all available diagnostic information and the clinical information obtained during the outpatient clinic assessment, and a six month follow-up period. The diagnostic accuracy, and value in addition to signs and symptoms of candidate serum biomarkers will be assessed in terms of discrimination with C statistics, and calibration with plots.
We aim to include 350 suspected cases, with 250 patients with indeed definite TIA (or minor stroke) according to the panel.

Discussion

We hope to find novel biomarkers that will enable a rapid and accurate diagnosis of TIA. This would largely improve the management and prognosis of such patients.

Trial registration

ClinicalTrials.gov Identifier NCT01954329
Literature
1.
go back to reference Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Gray A, Scarborough P, et al. European Heart Network. Brussels, Sophia Antipolis: European Society of Cardiology; 2012. Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Gray A, Scarborough P, et al. European Heart Network. Brussels, Sophia Antipolis: European Society of Cardiology; 2012.
2.
go back to reference Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke. 2009;40:2276–93.CrossRefPubMed Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke. 2009;40:2276–93.CrossRefPubMed
3.
go back to reference Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2007;6:1063–72.CrossRefPubMed Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2007;6:1063–72.CrossRefPubMed
4.
go back to reference Wu CM, McLaughlin K, Lorenzetti DL, Hill MD, Manns BJ, Ghali WA. Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med. 2007;167:2417–22.CrossRefPubMed Wu CM, McLaughlin K, Lorenzetti DL, Hill MD, Manns BJ, Ghali WA. Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med. 2007;167:2417–22.CrossRefPubMed
5.
go back to reference Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370:1432–42.CrossRefPubMed Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370:1432–42.CrossRefPubMed
6.
go back to reference Kappelle LJ. A transient ischaemic attack (TIA) is an emergency. Ned Tijdschr Geneeskd. 2007;151:2761–3.PubMed Kappelle LJ. A transient ischaemic attack (TIA) is an emergency. Ned Tijdschr Geneeskd. 2007;151:2761–3.PubMed
7.
go back to reference Luengo-Fernandez R, Gray AM, Rothwell PM. Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): a prospective population-based sequential comparison. Lancet Neurol. 2009;8:235–43.CrossRefPubMed Luengo-Fernandez R, Gray AM, Rothwell PM. Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): a prospective population-based sequential comparison. Lancet Neurol. 2009;8:235–43.CrossRefPubMed
8.
go back to reference Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk M, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369:293–8.CrossRefPubMedPubMedCentral Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk M, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007;369:293–8.CrossRefPubMedPubMedCentral
9.
go back to reference Amarenco P, Labreuche J, Lavallee PC. Patients with transient ischemic attack with ABCD2 < 4 can have similar 90-day stroke risk as patients with transient ischemic attack with ABCD2 >/=4. Stroke. 2012;43:863–5.CrossRefPubMed Amarenco P, Labreuche J, Lavallee PC. Patients with transient ischemic attack with ABCD2 < 4 can have similar 90-day stroke risk as patients with transient ischemic attack with ABCD2 >/=4. Stroke. 2012;43:863–5.CrossRefPubMed
10.
go back to reference Amort M, Fluri F, Schafer J, Weisskopf F, Katan M, Burow A, et al. Transient ischemic attack versus transient ischemic attack mimics: frequency, clinical characteristics and outcome. Cerebrovasc Dis. 2011;32:57–64.CrossRefPubMed Amort M, Fluri F, Schafer J, Weisskopf F, Katan M, Burow A, et al. Transient ischemic attack versus transient ischemic attack mimics: frequency, clinical characteristics and outcome. Cerebrovasc Dis. 2011;32:57–64.CrossRefPubMed
11.
go back to reference Fonseca AC, Canhao P. Diagnostic difficulties in the classification of transient neurological attacks. Eur J Neurol. 2011;18:644–8.CrossRefPubMed Fonseca AC, Canhao P. Diagnostic difficulties in the classification of transient neurological attacks. Eur J Neurol. 2011;18:644–8.CrossRefPubMed
12.
go back to reference Jensen MB, Chacon MR, Sattin JA, Aleu A, Lyden PD. The promise and potential pitfalls of serum biomarkers for ischemic stroke and transient ischemic attack. Neurologist. 2008;14:243–6.CrossRefPubMedPubMedCentral Jensen MB, Chacon MR, Sattin JA, Aleu A, Lyden PD. The promise and potential pitfalls of serum biomarkers for ischemic stroke and transient ischemic attack. Neurologist. 2008;14:243–6.CrossRefPubMedPubMedCentral
13.
go back to reference Kernagis DN, Laskowitz DT. Evolving role of biomarkers in acute cerebrovascular disease. Ann Neurol. 2012;71:289–303.CrossRefPubMed Kernagis DN, Laskowitz DT. Evolving role of biomarkers in acute cerebrovascular disease. Ann Neurol. 2012;71:289–303.CrossRefPubMed
15.
go back to reference Harrell Jr FE, Lee KL, Califf RM, Pryor DB, Rosati RA. Regression modelling strategies for improved prognostic prediction. Stat Med. 1984;3:143–52.CrossRefPubMed Harrell Jr FE, Lee KL, Califf RM, Pryor DB, Rosati RA. Regression modelling strategies for improved prognostic prediction. Stat Med. 1984;3:143–52.CrossRefPubMed
16.
go back to reference Lavellee PC, Mesequer E, Abboud H, Cabrejo L, Olivot JM, Simon O, et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol. 2007;6:953–60.CrossRef Lavellee PC, Mesequer E, Abboud H, Cabrejo L, Olivot JM, Simon O, et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol. 2007;6:953–60.CrossRef
17.
go back to reference Castle J, Mlynash M, Lee K, Caulfield AF, Wolford C, Kemp S, et al. Agreement regarding diagnosis of transient ischemic attack fairly low among stroke-trained neurologists. Stroke. 2010;41:1367–70.CrossRefPubMed Castle J, Mlynash M, Lee K, Caulfield AF, Wolford C, Kemp S, et al. Agreement regarding diagnosis of transient ischemic attack fairly low among stroke-trained neurologists. Stroke. 2010;41:1367–70.CrossRefPubMed
18.
go back to reference Moons KG, Grobbee DE. When should we remain blind and when should our eyes remain open in diagnostic studies? J Clin Epidemiol. 2002;55:633–6.CrossRefPubMed Moons KG, Grobbee DE. When should we remain blind and when should our eyes remain open in diagnostic studies? J Clin Epidemiol. 2002;55:633–6.CrossRefPubMed
19.
go back to reference Reitsma JB, Rutjes AW, Khan KS, Coomarasamy A, Bossuyt PM. A review of solutions for diagnostic accuracy studies with an imperfect or missing reference standard. J Clin Epidemiol. 2009;62:797–806.CrossRefPubMed Reitsma JB, Rutjes AW, Khan KS, Coomarasamy A, Bossuyt PM. A review of solutions for diagnostic accuracy studies with an imperfect or missing reference standard. J Clin Epidemiol. 2009;62:797–806.CrossRefPubMed
20.
go back to reference Wunderlich MT, Hanhoff T, Goertler M, Spener F, Glatz J, Wallesch CW, et al. Release of brain-type and heart-type fatty acid-binding proteins in serum after acute ischaemic stroke. J Neurol. 2005;252:718–24.CrossRefPubMed Wunderlich MT, Hanhoff T, Goertler M, Spener F, Glatz J, Wallesch CW, et al. Release of brain-type and heart-type fatty acid-binding proteins in serum after acute ischaemic stroke. J Neurol. 2005;252:718–24.CrossRefPubMed
21.
go back to reference Allard L, Burkhard PR, Lescuyer P, Burgess JA, Walter N, Hochstrasser DF, et al. PARK7 and nucleoside diphosphate kinase A as plasma markers for the early diagnosis of stroke. Clin Chem. 2005;51:2043–51.CrossRefPubMed Allard L, Burkhard PR, Lescuyer P, Burgess JA, Walter N, Hochstrasser DF, et al. PARK7 and nucleoside diphosphate kinase A as plasma markers for the early diagnosis of stroke. Clin Chem. 2005;51:2043–51.CrossRefPubMed
22.
go back to reference Allard L, Turck N, Burkhard PR, Walter N, Rosell A, Gex-Fabry M, et al. Ubiquitin fusion degradation protein 1 as a blood marker for the early diagnosis of ischemic stroke. Biomark Insights. 2007;2:155–64.PubMedPubMedCentral Allard L, Turck N, Burkhard PR, Walter N, Rosell A, Gex-Fabry M, et al. Ubiquitin fusion degradation protein 1 as a blood marker for the early diagnosis of ischemic stroke. Biomark Insights. 2007;2:155–64.PubMedPubMedCentral
23.
go back to reference Dambinova SA, Bettermann K, Glynn T, Tews M, Olson D, Weissman DJ, et al. Diagnostic potential of the NMDA receptor peptide assay for acute ischemic stroke. PLoS One. 2012;7:e42362.CrossRefPubMedPubMedCentral Dambinova SA, Bettermann K, Glynn T, Tews M, Olson D, Weissman DJ, et al. Diagnostic potential of the NMDA receptor peptide assay for acute ischemic stroke. PLoS One. 2012;7:e42362.CrossRefPubMedPubMedCentral
24.
go back to reference Weissman JD, Khunteev GA, Heath R, Dambinova SA. NR2 antibodies: risk assessment of transient ischemic attack (TIA)/stroke in patients with history of isolated and multiple cerebrovascular events. J Neurol Sci. 2011;300:97–102.CrossRefPubMed Weissman JD, Khunteev GA, Heath R, Dambinova SA. NR2 antibodies: risk assessment of transient ischemic attack (TIA)/stroke in patients with history of isolated and multiple cerebrovascular events. J Neurol Sci. 2011;300:97–102.CrossRefPubMed
Metadata
Title
Serum biomarkers for the early diagnosis of TIA: The MIND-TIA study protocol
Authors
L. Servaas Dolmans
Frans H. Rutten
Marie-Louise EL Bartelink
Gerdien Seppenwoolde
Sanne van Delft
L. Jaap Kappelle
Arno W. Hoes
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2015
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-015-0388-z

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